Korean J Gastroenterol.  2020 May;75(5):300-304. 10.4166/kjg.2020.75.5.300.

Pyogenic Liver Abscess or Liver Cyst Infection after Colonoscopic Polypectomy

• Kim TH
• Heo NY
• Park SH
• Moon YS
• Kim TO
• Park J
• Choi JH
• Park YE
• Lee J

• KMID: 2504250
• DOI: http://doi.org/10.4166/kjg.2020.75.5.300

Abstract

A pyogenic liver abscess (PLA) mostly occurs in association with biliary tract disease, but some PLAs have no apparent underlying cause, i.e., they are cryptogenic. The authors experienced three cases of PLA or liver cyst infection after colon polypectomy without other distinct etiologies. These cases suggest that colonoscopic polypectomy can cause a mucosal defect that provides a route for bacteria to invade the portal system or spread intraperitoneally to the liver. Colonoscopic polypectomy should be considered as a procedure that might cause PLA. Moreover, clinicians should be aware of this possibility if a patient complains of fever or abdominal pain after a colonoscopic polypectomy.

Keyword

Liver abscess, pyogenic; Colonoscopy

Figure

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  Fig. 1 (A) In case 1, the initial abdominal computed tomography showed a 3.5-cm lobulated low-attenuation lesion in segment eight in the right hepatic lobe. (B) Thrombus was shown in the middle hepatic vein (arrow). (C) Ultrasonography on aspiration revealed an ill-defined hypoechogenic lesion in the right hepatic lobe (arrowheads). (D) Follow-up ultrasonography after 6 months showed an ill-defined iso-echogenic area in the previous abscess pocket (asterisks).

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  Fig. 2 (A) In case 2, the initial abdominal computed tomography (CT) showed a 2.5-cm lobulated low-attenuated mass abutting the hepatic capsule in the left lateral segment of the liver (arrow). (B) On sono-guided aspiration, the lesion was observed as a heterogeneous echogenic mass with a low echogenic soap-bubble-like mass (asterisks). (C) Follow-up CT was performed 2 weeks later. The abscess showed improvement (arrow).

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  Fig. 3 (A-C) In case 3, colonoscopy 2 weeks before showed a transverse colon polyp, which was removed by snare polypectomy.

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  Fig. 4 (A) In case 3, abdominal computed tomography (CT) performed 6 months prior to admission showed multiple simple hepatic cysts. (B) Upon admission, CT showed that the wall of the largest cyst was enhanced with adjacent hyperemic change (arrow). (C) One week later, the size of the complicated cyst with the catheter decreased.

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